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General NPI Number Information
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NPI Number | 1407206691
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Entity Type | Individual
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Provider Name | HESHAM BAPACKER
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Gender | Male
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Dates
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Enumeration Date | 06/17/2016
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Last Update Date | 06/17/2016
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Provider Practice Location Address
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Address Line | 4110 E 9 MILE RD
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City | WARREN
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State | MI
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Zip | 48091-2501
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Country | US
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Telephone | 586-756-8070
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 RIVERSIDE
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City | DEARBORN
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State | MI
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Zip | 48120-1720
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Country | US
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Telephone | 313-575-9446
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302041752
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License Number State | MI
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